Latest ACA Enrollment Figures Released by HHS

July 22, 2016

On June 30th, the Department of Health and Human Services (HHS) released revised enrollment figures for the health insurance exchanges established by the Affordable Care Act (ACA). This report indicates how many consumers maintained coverage through March, 2016. As of March 31st roughly 11.1 million consumers had an active policy and had paid their premiums as of that date. The 11.1 million total enrollees is approximately 1 million more individuals with effectuated Health Insurance Marketplace coverage than at this time in 2015.

Earlier this year, HHS had announced that over 2 million new people had, for the first time, signed up for health coverage available as a result of enactment of the ACA. It turns out that many of these never actually paid their share of the premium and they have now been dropped from the rolls.

The 11.1 million enrollees is a decrease of 1.6 million individuals (13 percent) from the 12.7 million individuals originally enrolled at the end of the 2016 open enrollment period. The drop-off is not unexpected, however, and the retention rate of 87 percent is in line with HHS’ goal of having 10 million individuals still enrolled in the effectuated Health Insurance Marketplace by the end of 2016. The vast majority of those 1.6 million lost their coverage as a result of not paying their premiums.

Of the 11.1 million consumers covered as of March 31st, around 85 percent were receiving financial assistance for their premium payments through an advance payment of the premium tax credit (APTC) and 57 percent were receiving a cost sharing reduction (CSR). The average APTC for qualifying individuals was $291 a month, the highest APTC per month was Alaska at $750 a month and the lowest was New York at $178 a month. The three states with the highest rate of consumers receiving financial assistance through APTC were Mississippi, Florida, and Louisiana. The three states with the lowest were the District of Columbia, New York and Colorado.

About 8.4 million of the 11.1 million total enrollees were enrolled through the 38 FederallyFacilitated Marketplaces and the remaining 2.7 million were enrolled through State-based Marketplaces. Around 70 percent of enrollees had purchased silver-level plans. Of note, the Consumer Operated and Oriented Plan (CO-OP) program established by the ACA to bring small-size government-funded insurance providers to local markets continues to struggle.

The CO-OP program was hit especially hard by the budget-neutral risk-adjustment program that was meant to bring stability to insurance providers under the ACA but instead created a massive financial shortfall for Plans and providers. While the larger providers have largely been able to weather the shortfall of risk-corridor payments, the CO-OPs have not. Subsequently, of the 23 original CO-OPs only 9 remain with the recent announcement of the closing of Connecticut’s CO-OP HealthyCT.

The latest ACA enrollment figures tell a mixed story. There is a definitive improvement in the number of enrollees from 2015 to 2016; however, the figures are still far lower than prior years’ projections from the Congressional Budget Office, which have been subsequently lowered in their 2016 report. Nonetheless, despite the imperfections of the ACA the nation’s uninsured rate currently stands at an all-time low of nine percent.

The vast majority of the newly insured are being covered by the Medicaid expansion initiative rather than through the purchase of private health insurance.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.